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McKinlay CJD, Anderson C, Cheong JLY, Gordon A, Harris SL, Hurrion EM, Ireland S, Koorts P, Lui K, Mackay L, Oakes-Ter Bals M, Opie G, Sharp M, Groom KM. Childhood outcomes after maternal antenatal sildenafil treatment for severe early-onset fetal growth restriction: a randomized trial (STRIDER NZAus). J Perinatol 2024; 44:396-403. [PMID: 38057497 DOI: 10.1038/s41372-023-01838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
In this follow-up at 2.5 years of children from the STRIDER NZAus Trial (N = 112), in which women with singleton pregnancies affected by severe early fetal growth restriction were randomized to sildenafil citrate 75 mg daily or placebo until 32 weeks, there was no difference between groups in survival without neurosensory impairment, defined as any of cerebral palsy, deafness, blindness, cognitive delay (Bayley III cognition or language score >1 SD below mean) or motor delay: 30/56[54%] vs. 34/56[61%]; aOR = 0.74, 95%CI: 0.31, 1.77. However, children exposed to sildenafil appeared to be more likely to have cognitive delay (13/45[29%] vs. 4/40[10%]; aOR = 3.71, 95% CI: 1.01, 13.63) but less likely to have emotional-behavioural difficulties (2/43[5%] vs. 8/38[21%]; aOR = 0.19, 95%CI: 0.03, 1.00). Conclusion: maternal sildenafil treatment for severe early-onset FGR was not associated with altered survival free of neurosensory impairment at 2.5 years' corrected age.
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Affiliation(s)
- Christopher J D McKinlay
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
- Kidz First Neonatal Care, Counties Manukau Health, Auckland, New Zealand.
| | - Chad Anderson
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - Jeanie L Y Cheong
- Royal Women's Hospital, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | | | - Sarah L Harris
- University of Otago, Christchurch, New Zealand
- Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Elizabeth M Hurrion
- Mater Mothers' Hospital, Brisbane, QLD, Australia
- Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Susan Ireland
- Townsville University Hospital, Townsville, QLD, Australia
| | - Pieter Koorts
- Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Kei Lui
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Laura Mackay
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Gillian Opie
- Mercy Hospital for Women, Melbourne, VIC, Australia
| | - Mary Sharp
- King Edward Memorial Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Katie M Groom
- Liggins Institute, University of Auckland, Auckland, New Zealand.
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Gould JF, Roberts RM, Anderson PJ, Makrides M, Sullivan TR, Gibson RA, McPhee AJ, Doyle LW, Bednarz JM, Best KP, Opie G, Travadi J, Cheong JLY, Davis PG, Sharp M, Simmer K, Tan K, Morris S, Lui K, Bolisetty S, Liley H, Stack J, Collins CT. High-Dose Docosahexaenoic Acid in Newborns Born at Less Than 29 Weeks' Gestation and Behavior at Age 5 Years: Follow-Up of a Randomized Clinical Trial. JAMA Pediatr 2024; 178:45-54. [PMID: 37983037 PMCID: PMC10660239 DOI: 10.1001/jamapediatrics.2023.4924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/14/2023] [Indexed: 11/21/2023]
Abstract
Importance Children born at less than 29 weeks' gestation are at risk of behavioral difficulties. This may be due in part to the lack of transplacental supply of docosahexaenoic acid (DHA), a key fatty acid with structural and functional roles in the brain. Objective To determine whether meeting the neonatal DHA requirement through supplementation is associated with improved behavioral functioning of children born at less than 29 weeks' gestation. Design, Setting and Participants This was a follow-up of children from 10 Australian participating centers in a multi-center, blinded, parallel group randomized clinical trial of infants born at less than 29 weeks' gestation conducted from June 2012 and September 2015, excluding those with additional fatty acid supplementation or major congenital or chromosomal abnormalities. Follow-up took place from August 2018 to May 2021. Parents of surviving children who had not withdrawn from the original trial were invited to complete questionnaires when the child turned 5 years' corrected age. Interventions Infants were randomized to receive daily enteral emulsions providing 60 mg/kg/d of DHA or a soy-oil emulsion (with no DHA) from within the first 3 days of enteral feeding until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Main Outcomes and Measures The primary outcome of this follow-up was parent-rated behavior and emotional functioning as indicated by the Total Difficulties score of the Strengths and Difficulties Questionnaire. Parents also completed questionnaires about their child's behavioral manifestations of executive functioning, as well as a range of health outcomes to assess potential longer-term side effects of DHA intervention. Results Primary outcome data were available for 731 children (76% of 958 surviving eligible children; 361 in the intervention group and 370 in the control group). Of these 731, 452 (47%) were female, and the mean (SD) corrected age at follow-up was 5.4 (0.5) years. Following imputation for missing data, the mean Total Difficulties score was the same in both groups (intervention group, n = 465; mean [SD], 11.8 [6.3]; control group, n = 493; mean [SD], 11.8 [6.0]; mean difference adjusted for sex, gestational age stratum, and hospital, 0.01; 95% CI, -0.87 to 0.89; P = .98). There was no evidence for differences between the groups in any secondary outcomes of behavior, executive functioning, or health. Conclusions and Relevance In this follow-up of a randomized clinical trial, enteral DHA supplementation at the equivalent of the estimated in utero dose for infants born at less than 29 weeks' gestation did not improve behavioral functioning at age 5 years. There were no indications of adverse effects with DHA supplementation. Trial Registration Australian New Zealand Clinical Trial Registry: ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F. Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Adelaide, South Australia, Australia
| | - Rachel M. Roberts
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, Adelaide, South Australia, Australia
| | - Peter J. Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
| | - Thomas R. Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
| | - Robert A. Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, The University of Adelaide, Waite Campus, Glen Osmond, South Australia, Australia
| | - Andrew J. McPhee
- Neonatal Medicine, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
| | - Lex W. Doyle
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia
| | - Jana M. Bednarz
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Karen P. Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children’s Hospital, New Lambton Heights, New South Wales, Australia
- Neonatal Intensive Care Unit, Department of Paediatrics, Te Whatu Ora Waikato, Waikato Hospital, Hamilton, New Zealand
| | - Jeanie L. Y. Cheong
- Neonatal Medicine, The Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia
| | - Peter G. Davis
- Neonatal Medicine, The Royal Women’s Hospital, Parkville, Melbourne, Victoria, Australia
| | - Mary Sharp
- King Edward Memorial Hospital, Perth, Western Australia, Australia
| | - Karen Simmer
- The University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Monash Children’s Hospital, Clayton, Victoria, Australia
| | - Scott Morris
- Neonatal-Perinatal Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia
| | - Kei Lui
- School of Clinical Medicine, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Helen Liley
- Mater Research – The Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jacqueline Stack
- Neonatal Intensive Care Unit, Liverpool Hospital, Elizabeth, Liverpool, New South Wales, Australia
| | - Carmel T. Collins
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
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Doyle LW, Ranganathan S, Spittle A, Opie G, Mainzer R, Cheong JL. Expiratory airflow at 7-8 years of age in children born extremely low birthweight from 14 years before to 14 years after the introduction of exogenous surfactant. EClinicalMedicine 2023; 62:102115. [PMID: 37533420 PMCID: PMC10393553 DOI: 10.1016/j.eclinm.2023.102115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
Background It is unclear if expiratory airflow in survivors born extremely low birth weight (ELBW; 500-999 g) has improved after the introduction of exogenous surfactant into clinical practice in 1991. The primary aim of this study was to describe the changes in airflow at 7-8 years of age of survivors born ELBW in five discrete cohorts from 14 years before to 14 years after the introduction of exogenous surfactant into clinical practice. Methods The cohorts comprised consecutive survivors born ELBW in 1977-82 and 1985-87 at the Royal Women's Hospital, Melbourne, and in 1991-92, 1997 and 2005 in the state of Victoria, Australia. Survival rates to 2-years of age for infants born ELBW in the state of Victoria rose from approximately 1-in-4 to 3-in-4 over the time of this study. Expiratory airflow measurements at 7-8 years included the forced expired volume in 1 s (FEV1), converted to z-scores for age, height, sex, and race. Findings There were 596 ELBW participants with expiratory flow data, 280 (47%) of whom had bronchopulmonary dysplasia (BPD). Overall, there was little change in zFEV1 over the 28-year period (mean change per year; 0.003, 95% CI -0.010, 0.015, P = 0.67). There was, however, evidence of an interaction between BPD and year; zFEV1 in those who had BPD fell over time (mean change per year -0.019, 95% CI -0.037, -0.009, P = 0.035), whereas zFEV1 improved in those who did not have BPD (mean change per year 0.021, 95% CI 0.006, 0.037, P = 0.007). Interpretation Contrary to recent evidence, expiratory airflow of children born ELBW has not improved with the introduction of surfactant, and may be deteriorating in those who had BPD. Funding National Health and Medical Research Council (Australia); Victorian Government's Operational Infrastructure Support Program.
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Affiliation(s)
- Lex W. Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - S. Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - A.J. Spittle
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - G. Opie
- Neonatal Services, Mercy Hospital for Women, Melbourne, Australia
| | - R.M. Mainzer
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Clinical Epidemiology and Biostatistics, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jeanie L.Y. Cheong
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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Stark MJ, Collins CT, Andersen CC, Crawford TM, Sullivan TR, Bednarz J, Morton R, Marks DC, Dieng M, Owen LS, Opie G, Travadi J, Tan K, Morris S. Study protocol of the WashT Trial: transfusion with washed versus unwashed red blood cells to reduce morbidity and mortality in infants born less than 28 weeks' gestation - a multicentre, blinded, parallel group, randomised controlled trial. BMJ Open 2023; 13:e070272. [PMID: 37487676 PMCID: PMC10373745 DOI: 10.1136/bmjopen-2022-070272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Many extremely preterm newborns develop anaemia requiring a transfusion, with most receiving three to five transfusions during their admission. While transfusions save lives, the potential for transfusion-related adverse outcomes is an area of growing concern. Transfusion is an independent predictor of death and is associated with increased morbidity, length of hospital stay, risk of infection and immune modulation. The underlying mechanisms include adverse pro-inflammatory and immunosuppressive responses. Evidence supports an association between transfusion of washed red cells and fewer post-transfusion complications potentially through removal of chemokines, lipids, microaggregates and other biological response modifiers. However, the clinical and cost-effectiveness of washed cells have not been determined. METHODS AND ANALYSIS This is a multicentre, randomised, double-blinded trial of washed versus unwashed red cells. Infants <28 weeks' gestation requiring a transfusion will be enrolled. Transfusion approaches will be standardised within each study centre and will occur as soon as possible with a recommended fixed transfusion volume of 15 mL/kg whenever the haemoglobin is equal to or falls below a predefined restrictive threshold, or when clinically indicated. The primary outcome is a composite of mortality and/or major morbidity to first discharge home, defined as one or more of the following: physiologically defined bronchopulmonary dysplasia; unilateral or bilateral retinopathy of prematurity grade >2, and; necrotising enterocolitis stage ≥2. To detect a 10% absolute reduction in the composite outcome from 69% with unwashed red blood cell (RBCs) to 59% with washed RBCs with 90% power, requires a sample size of 1124 infants (562 per group). Analyses will be performed on an intention-to-treat basis with a prespecified statistical analysis plan. A cost-effectiveness analysis will also be undertaken. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Women's and Children's Health Network Human Research Ethics Committee (HREC/12/WCHN/55). The study findings will be disseminated through peer-reviewed articles and conferences. TRIAL REGISTRATION NUMBER ACTRN12613000237785 Australian New Zealand Clinical Trials Registry.
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Affiliation(s)
- Michael J Stark
- Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Carmel T Collins
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Chad C Andersen
- Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
| | - Tara M Crawford
- Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jana Bednarz
- SAHMRI Women and Kids Theme, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachael Morton
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood New South Wales and Australian Capital Territory, Teams, New South Wales, Australia
| | - Mbathio Dieng
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise S Owen
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Critical Care and Neurosciences Division, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Gillian Opie
- Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Javeed Travadi
- Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Kenneth Tan
- Monah Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Scott Morris
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Neonatal Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Cheong JL, Olsen JE, Konstan T, Mainzer RM, Hickey LM, Spittle AJ, Wark JD, Cheung MM, Garland SM, Duff J, Clark M, Stevens P, Doyle LW, Anderson P, Boland R, Burnett A, Charlton M, Clark M, Davis N, Doyle L, Duff J, Hickey L, Johnston E, Josev E, Lee K, Mainzer R, McDonald M, Novella B, Olsen J, Opie G, Pigdon L, Roberts G, Spittle A, Stevens P, Stewart A, Turner AM, Woods T. Growth from infancy to adulthood and associations with cardiometabolic health in individuals born extremely preterm. The Lancet Regional Health - Western Pacific 2023. [DOI: 10.1016/j.lanwpc.2023.100717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Gould JF, Roberts RM, Anderson PJ, Makrides M, Sullivan TR, Gibson RA, McPhee AJ, Doyle LW, Opie G, Travadi J, Cheong JLY, Davis PG, Sharp M, Simmer K, Tan K, Morris S, Lui K, Bolisetty S, Liley H, Stack J, Best KP, Collins CT. Protocol for assessing if behavioural functioning of infants born <29 weeks' gestation is improved by omega-3 long-chain polyunsaturated fatty acids: follow-up of a randomised controlled trial. BMJ Open 2021; 11:e044740. [PMID: 33952546 PMCID: PMC8103387 DOI: 10.1136/bmjopen-2020-044740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the last trimester of pregnancy, the fetal brain undergoes a rapid growth spurt and accumulates essential nutrients including docosahexaenoic acid (DHA). This takes place ex-utero for infants born <29 weeks' gestation, without the in-utero provisions of DHA. Infants born <29 weeks' are more likely to experience behavioural and emotional difficulties than their term-born counterparts. It has been hypothesised that supplementing preterm infants with dietary DHA may alleviate insufficiency and subsequently prevent or minimise behavioural problems. This protocol describes a follow-up of infants born <29 weeks gestation who were enrolled in a randomised controlled trial (RCT) of DHA supplementation. We aim to determine whether DHA supplementation improves the behaviour, and general health of these infants. METHODS AND ANALYSIS Infants born <29 weeks' gestation were enrolled in a multicentre blinded RCT of enteral DHA supplementation. Infants were randomised to receive an enteral emulsion that provided 60 mg/kg/day of DHA or a control emulsion commenced within the first 3 days of enteral feeding, until 36 weeks' postmenstrual age or discharge home, whichever occurred first. Families of surviving children (excluding those who withdrew from the study) from the Australian sites (up to 955) will be invited to complete a survey. The survey will include questions regarding child behavioural and emotional functioning, executive functioning, respiratory health and general health. We hypothesise that the DHA intervention will have a benefit on the primary outcome, parent-rated behaviour and emotional status as measured using the Total Difficulties score of the Strengths and Difficulties Questionnaire. Detecting a 2-point difference between groups (small effect size of 0.25 SD) with 90% power will require follow-up of 676 participants. ETHICS AND DISSEMINATION The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/16/WCHN/184). Results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F Gould
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology and Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maria Makrides
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robert A Gibson
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Waite Campus, Glen Osmond, South Australia, Australia
| | - Andrew J McPhee
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Lex William Doyle
- Department Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeanie L Y Cheong
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Peter G Davis
- Neonatal Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Mary Sharp
- Neonatal Follow up, King Edward Memorial Hospital for Women Perth, Perth, Western Australia, Australia
| | - Karen Simmer
- Neonatal Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
- Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Scott Morris
- Paediatric Neonatal Clinic, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Kei Lui
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Srinivas Bolisetty
- Newborn Care Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Helen Liley
- Mater Research - The Faculty of Medicine, The University of Queensland, South Brisbane, Queensland, Australia
| | - Jacqueline Stack
- Neonatal Intensive Care Unit, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Karen P Best
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Women and Kids, South Australian Health and Medical Research Institute, North Adelaide, South Australia, Australia
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7
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Gould JF, Makrides M, Sullivan TR, Anderson PJ, Gibson RA, Best KP, McPhee AJ, Doyle LW, Opie G, Travadi J, Cheong J, Davis PG, Sharp M, Simmer K, Collins CT. Protocol for assessing whether cognition of preterm infants <29 weeks' gestation can be improved by an intervention with the omega-3 long-chain polyunsaturated fatty acid docosahexaenoic acid (DHA): a follow-up of a randomised controlled trial. BMJ Open 2021; 11:e041597. [PMID: 33550243 PMCID: PMC7925903 DOI: 10.1136/bmjopen-2020-041597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Docosahexaenoic acid (DHA) is an omega-3 (n-3) fatty acid that accumulates into neural tissue during the last trimester of pregnancy, as the fetal brain is undergoing a growth spurt. Infants born <29 weeks' gestation are deprived the normal in utero supply of DHA during this period of rapid brain development. Insufficient dietary DHA postnatally may contribute to the cognitive impairments common among this population. This follow-up of the N-3 fatty acids for improvement in respiratory outcomes (N3RO) randomised controlled trial aims to determine if enteral DHA supplementation in infants born <29 weeks' gestation during the first months of life improves cognitive development at 5 years of age corrected for prematurity. METHODS AND ANALYSIS N3RO was a randomised controlled trial of enteral DHA supplementation (60 mg/kg/day) or a control emulsion (without DHA) in 1273 infants born <29 weeks' gestation to determine the effect on bronchopulmonary dysplasia (BPD). We showed that DHA supplementation did not reduce the risk of BPD and may have increased the risk.In this follow-up at 5 years' corrected age, a predefined subset (n=655) of children from five Australian sites will be invited to attend a cognitive assessment with a psychologist. Children will be administered the Wechsler Preschool and Primary Scale of Intelligence (fourth edition) and a measure of inhibitory control (fruit stroop), while height, weight and head circumference will be measured.The primary outcome is full-scale IQ. To ensure 90% power, a minimum of 592 children are needed to detect a four-point difference in IQ between the groups.Research personnel and families remain blinded to group assignment. ETHICS AND DISSEMINATION The Women's and Children Health Network Human Research Ethics Committee reviewed and approved the study (HREC/17/WCHN/187). Caregivers will give informed consent prior to taking part in this follow-up study. Findings of this study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12612000503820.
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Affiliation(s)
- Jacqueline F Gould
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Psychology & Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Maria Makrides
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Robert A Gibson
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Agriculture, Food and Wine, University of Adelaide, Adelaide, South Australia, Australia
| | - Karen P Best
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Andrew J McPhee
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Lex William Doyle
- Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Gillian Opie
- Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Javeed Travadi
- Newborn Services, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Jeanie Cheong
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Peter G Davis
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Mary Sharp
- King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
| | - Karen Simmer
- Neonatal Research, The University of Western Australia, Perth, Western Australia, Australia
| | - Carmel T Collins
- Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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8
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Cheong JLY, Olsen JE, Huang L, Dalziel KM, Boland RA, Burnett AC, Haikerwal A, Spittle AJ, Opie G, Stewart AE, Hickey LM, Anderson PJ, Doyle LW. Changing consumption of resources for respiratory support and short-term outcomes in four consecutive geographical cohorts of infants born extremely preterm over 25 years since the early 1990s. BMJ Open 2020; 10:e037507. [PMID: 32912950 PMCID: PMC7488838 DOI: 10.1136/bmjopen-2020-037507] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is unclear how newer methods of respiratory support for infants born extremely preterm (EP; 22-27 weeks gestation) have affected in-hospital sequelae. We aimed to determine changes in respiratory support, survival and morbidity in EP infants since the early 1990s. DESIGN Prospective longitudinal cohort study. SETTING The State of Victoria, Australia. PARTICIPANTS All EP births offered intensive care in four discrete eras (1991-1992 (24 months): n=332, 1997 (12 months): n=190, 2005 (12 months): n=229, and April 2016-March 2017 (12 months): n=250). OUTCOME MEASURES Consumption of respiratory support, survival and morbidity to discharge home. Cost-effectiveness ratios describing the average additional days of respiratory support associated per additional survivor were calculated. RESULTS Median duration of any respiratory support increased from 22 days (1991-1992) to 66 days (2016-2017). The increase occurred in non-invasive respiratory support (2 days (1991-1992) to 51 days (2016-2017)), with high-flow nasal cannulae, unavailable in earlier cohorts, comprising almost one-half of the duration in 2016-2017. Survival to discharge home increased (68% (1991-1992) to 87% (2016-2017)). Cystic periventricular leukomalacia decreased (6.3% (1991-1992) to 1.2% (2016-2017)), whereas retinopathy of prematurity requiring treatment increased (4.0% (1991-1992) to 10.0% (2016-2017)). The average additional costs associated with one additional infant surviving in 2016-2017 were 200 (95% CI 150 to 297) days, 326 (183 to 1127) days and 130 (70 to 267) days compared with 1991-1992, 1997 and 2005, respectively. CONCLUSIONS Consumption of resources for respiratory support has escalated with improved survival over time. Cystic periventricular leukomalacia reduced in incidence but retinopathy of prematurity requiring treatment increased. How these changes translate into long-term respiratory or neurological function remains to be determined.
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Affiliation(s)
- Jeanie L Y Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Joy E Olsen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Li Huang
- Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Kim M Dalziel
- Centre for Health Policy, University of Melbourne, Parkville, Victoria, Australia
| | - Rosemarie A Boland
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Nursing, University of Melbourne, Parkville, Victoria, Australia
- Paediatric Infant Perinatal Emergency Retrieval, , Royal Children's Hospital, Parkville, Victoria, Australia
- Safer Care Victoria, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Alice C Burnett
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Anjali Haikerwal
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | - Gillian Opie
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Alice E Stewart
- Newborn Services, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Leah M Hickey
- Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Peter J Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Monash University Monash Institute of Cognitive and Clinical Neuroscience, Clayton, Victoria, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia
- Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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9
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Bolisetty S, Osborn D, Schindler T, Sinn J, Deshpande G, Wong CS, Jacobs SE, Phad N, Pharande P, Tobiansky R, Luig M, Trivedi A, Mcintosh J, Josza E, Opie G, Downe L, Andersen C, Bhatia V, Kumar P, Malinen K, Birch P, Simmer K, McLeod G, Quader S, Rajadurai VS, Hewson MP, Nair A, Williams M, Xiao J, Ravindranathan H, Broadbent R, Lui K. Standardised neonatal parenteral nutrition formulations - Australasian neonatal parenteral nutrition consensus update 2017. BMC Pediatr 2020; 20:59. [PMID: 32035481 PMCID: PMC7007668 DOI: 10.1186/s12887-020-1958-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. METHODS A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. RESULTS Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. CONCLUSIONS The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.
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Affiliation(s)
- Srinivas Bolisetty
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
- Conjoint Lecturer, University of New South Wales, Sydney, Australia
| | - David Osborn
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Tim Schindler
- Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - John Sinn
- University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | | | | | - Susan E. Jacobs
- Deputy Clinical Director and Neonatal Paediatrician, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Nilkant Phad
- John Hunter Children’s Hospital, Newcastle, Australia
| | | | | | | | - Amit Trivedi
- The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Eszter Josza
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
| | - Gillian Opie
- Head and Neonatal Paediatrician, Mercy Hospital for Women, Heidelberg, Victoria Australia
| | | | - Chad Andersen
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | - Vineesh Bhatia
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | | | - Katri Malinen
- PGCert Clinical Education, PGDip Child Health (associate), Advanced Pharmacist, Townsville Hospital, Townsville, Australia
| | - Pita Birch
- Gold Coast University Hospital, Southport, Australia
| | - Karen Simmer
- King Edward Memorial Hospital for Women, Subiaco, Australia
| | - Gemma McLeod
- King Edward Memorial and Princess Margaret Hospitals, Subiaco, Australia
| | - Suzanne Quader
- The Sydney Children’s Hospital Network, Sydney, Australia
| | | | | | - Arun Nair
- Waikato Hospital, Hamilton, New Zealand
| | | | | | | | | | - Kei Lui
- University of New South Wales, Sydney, Australia
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10
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Haikerwal A, Doyle LW, Cheung MM, Wark JD, Opie G, Roberts G, Patton G, Cheong JL. High Blood Pressure in Young Adult Survivors Born Extremely Preterm or Extremely Low Birthweight in the Post Surfactant Era. Hypertension 2020; 75:211-217. [DOI: 10.1161/hypertensionaha.119.13780] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More infants born extremely preterm (<28 weeks’ gestation) or extremely low birthweight (<1000 g) are surviving into adulthood in recent years. Preterm adolescents have higher blood pressure (BP) than normal birthweight controls, but how their BP changes with increasing age is not known. We compared BP at 25 years and trajectories of BP (change per year) from 18 to 25 years between survivors born <28 weeks/<1000 g and normal birthweight (>2499 g) controls born in the early 1990s, when survival rates began to rise. Participants were derived from 297 consecutive survivors born <28 weeks/<1000 g in 1991 to 1992 in Victoria, Australia, and 260 contemporaneous controls. At age 25 years, ambulatory BP was measured in 151 and 119 participants, respectively. Participants born <28 weeks/<1000 g had higher 24-hour systolic (mean difference 4.5 [95% CI, 1.2–7.7 mm Hg]), diastolic (3.4 [1.5–5.2 mm Hg]), and mean BPs (3.6 [1.4–5.8 mm Hg]) compared with the controls. Similar patterns were observed for both awake and asleep periods. Asleep ambulatory BP between 18 and 25 years increased more in participants born <28 weeks/<1000 g than in controls (systolic 0.56, diastolic 0.41, and mean 0.41 mm Hg increase per year; all
P
<0.05). Young adults born <28 weeks/<1000 g in the post surfactant era have higher BP and an increased trajectory of ambulatory BP compared with controls. With more survivors born <28 weeks/<1000 g now reaching adulthood, these findings are important for early detection and timely management of hypertension in this high-risk population.
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Affiliation(s)
- Anjali Haikerwal
- From the Newborn Services, The Royal Women’s Hospital, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
| | - Lex W. Doyle
- From the Newborn Services, The Royal Women’s Hospital, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Department of Obstetrics and Gynecology, The Royal Women’s Hospital (L.W.D., G.O., J.L.Y.C.), The University of Melbourne, Australia
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
| | - Michael M. Cheung
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
- Heart Research, Murdoch Children’s Research Institute, Melbourne, Australia (M.M.C.)
- Department of Cardiology, Royal Children’s Hospital, Melbourne, Australia (M.M.C.)
| | - John D. Wark
- Department of Medicine, The Royal Melbourne Hospital (J.D.W.), The University of Melbourne, Australia
- Bone and Mineral Medicine, The Royal Melbourne Hospital, Australia (J.D.W.)
| | - Gillian Opie
- Department of Obstetrics and Gynecology, The Royal Women’s Hospital (L.W.D., G.O., J.L.Y.C.), The University of Melbourne, Australia
- Neonatal Services, Mercy Hospital for Women, Melbourne, Australia (G.O.)
| | - Gehan Roberts
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
- Centre for Community Child Health (G.R.), Royal Children’s Hospital, Melbourne, Australia
| | - George Patton
- Department of Paediatrics (L.W.D., M.M.C., G.R., G.P.), The University of Melbourne, Australia
- Centre for Adolescent Health (G.P.), Royal Children’s Hospital, Melbourne, Australia
| | - Jeanie L.Y. Cheong
- From the Newborn Services, The Royal Women’s Hospital, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Australia (A.H., L.W.D., J.L.Y.C.)
- Department of Obstetrics and Gynecology, The Royal Women’s Hospital (L.W.D., G.O., J.L.Y.C.), The University of Melbourne, Australia
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11
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Doyle LW, Anderson PJ, Burnett A, Callanan C, McDonald M, Hayes M, Opie G, Carse E, Cheong JLY. Developmental Disability at School Age and Difficulty Obtaining Follow-up Data. Pediatrics 2018; 141:peds.2017-3102. [PMID: 29330314 DOI: 10.1542/peds.2017-3102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The relationship of developmental disability rates with difficulty obtaining follow-up data is unclear. With this study, we aimed to determine if children who attended research follow-up assessments with more difficulty had more disability at school age, compared with those who attended with less difficulty, and to establish the relationship between follow-up and disability rates. METHODS Two groups, comprising 219 consecutive survivors born at <28 weeks' gestation or at <1000 g birth weight in the state of Victoria, Australia, in 2005, and 218 term-born, normal birth weight controls were assessed at 8 years of age for neurodevelopmental disability (any of IQ <-1 SD, cerebral palsy, blindness, or deafness). Children were classified as either more or less difficult to get to attend by research nurses involved in the study. RESULTS The follow-up rate was 87% for both groups. Overall, children who attended with more difficulty had higher rates of neurodevelopmental disability (42%; 19 of 45) than those who attended with less difficulty (20%; 66 of 328) (odds ratio: 3.09, 95% confidence interval: 1.58 to 6.01; P = .001). As the follow-up rate rose among the 3 individual hospitals involved in the assessments, so did the rate of neurodevelopmental disability (P = .025). CONCLUSIONS Children who attend with more difficulty have higher rates of neurodevelopmental disability at school age than those who attend with less difficulty, and disability rates rise with higher follow-up rates. Rates of neurodevelopmental disability will be underestimated if researchers are not persistent enough to obtain high follow-up rates.
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Affiliation(s)
- Lex W Doyle
- Neonatal Services, Royal Women's Hospital, Parkville, Australia; .,Departments of Obstetrics and Gynaecology and.,Paediatrics, The University of Melbourne, Parkville, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia.,Monash Institute of Cognitive and Clinical Neurosciences and
| | - Alice Burnett
- Neonatal Services, Royal Women's Hospital, Parkville, Australia.,Paediatrics, The University of Melbourne, Parkville, Australia.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia
| | | | - Marion McDonald
- Neonatal Services, Royal Women's Hospital, Parkville, Australia
| | - Marie Hayes
- Department of Newborn Medicine, Monash Medical Centre, Monash University, Clayton, Australia; and
| | - Gillian Opie
- Department of Paediatrics, Mercy Hospital for Women, Heidelberg, Australia
| | - Elizabeth Carse
- Department of Newborn Medicine, Monash Medical Centre, Monash University, Clayton, Australia; and
| | - Jeanie L Y Cheong
- Neonatal Services, Royal Women's Hospital, Parkville, Australia.,Departments of Obstetrics and Gynaecology and.,Victorian Infant Brain Studies, Murdoch Children's Research Institute, Parkville, Australia
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12
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Abstract
BACKGROUND Assisted ventilation for extremely preterm infants (<28 weeks of gestation) has become less invasive, but it is unclear whether such developments in care are associated with improvements in short-term or long-term lung function. We compared changes over time in the use of assisted ventilation and oxygen therapy during the newborn period and in lung function at 8 years of age in children whose birth was extremely premature. METHODS We conducted longitudinal follow-up of all survivors of extremely preterm birth who were born in Victoria, Australia, in three periods - the years 1991 and 1992 (225 infants), 1997 (151 infants), and 2005 (170 infants). Perinatal data were collected prospectively, including data on the duration and type of assisted ventilation provided, the duration of oxygen therapy, and oxygen requirements at 36 weeks of age. Expiratory airflow was measured at 8 years of age, and values were converted to z scores for age, height, ethnic group, and sex. RESULTS The duration of assisted ventilation rose substantially over time, with a large increase in the duration of nasal continuous positive airway pressure. Despite the increase in the use of less invasive ventilation over time, the duration of oxygen therapy and the rate of oxygen dependence at 36 weeks rose, and airflows at 8 years of age were worse in 2005 than in earlier periods. For instance, for 2005 versus 1991-1992, the mean difference in the z scores for the ratio of forced expiratory volume in 1 second to forced vital capacity was -0.75 (95% confidence interval [CI], -1.07 to -0.44; P<0.001), and for 2005 versus 1997 the mean difference was -0.53 (95% CI, -0.86 to -0.19; P=0.002). CONCLUSIONS Despite substantial increases in the use of less invasive ventilation after birth, there was no significant decline in oxygen dependence at 36 weeks and no significant improvement in lung function in childhood over time. (Funded by the National Health and Medical Research Council of Australia and the Victorian Government's Operational Infrastructure Support Program.).
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Affiliation(s)
- Lex W Doyle
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Elizabeth Carse
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Anne-Marie Adams
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Sarath Ranganathan
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Gillian Opie
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
| | - Jeanie L Y Cheong
- From Neonatal Services, Royal Women's Hospital (L.W.D., J.L.Y.C.), the Departments of Obstetrics and Gynaecology (L.W.D., J.L.Y.C.) and Paediatrics (L.W.D., S.R.), University of Melbourne, Clinical Sciences (L.W.D., J.L.Y.C.) and Infection and Immunity (A.-M.A., S.R.), Murdoch Childrens Research Institute, Newborn Services, Monash Medical Centre (E.C.), Respiratory and Sleep Medicine, Royal Children's Hospital (A.-M.A., S.R.), and Neonatal Services, Mercy Hospital for Women (G.O.) - all in Melbourne, VIC, Australia
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13
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Beker F, Opie G, Noble E, Jiang Y, Bloomfield FH. Smell and Taste to Improve Nutrition in Very Preterm Infants: A Randomized Controlled Pilot Trial. Neonatology 2017; 111:260-266. [PMID: 27902988 DOI: 10.1159/000450883] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/19/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The perception of smell and taste, though present early in development, is not routinely considered in the care of preterm infants. Smell and taste are known to increase gut motility, insulin secretion, and the release of appetite, digestive and metabolic hormones. OBJECTIVE We aimed to investigate the effect of regular smell and taste on the time from birth to full enteral feeds, and the feasibility of the study protocol in very preterm infants. METHODS In a randomized controlled trial, infants <29 weeks' postmenstrual age (PA) were assigned to receive either the smell and taste of milk before each feed or to have no exposure to the smell and taste of milk (control). RESULTS Infants in the treatment group (n = 28) and control group (n = 23) were born at a mean (SD) PA of 26.7 (1.5) and 27.2 (1.4) weeks, respectively. They reached full enteral feeds at a median (IQR) of 13.5 (10.0-19.0) and 15.5 (11.0-22.0) days, respectively. Survival analysis showed an adjusted hazard ratio of 1.63 (95% confidence interval 0.91-2.91; p = 0.10) for the effect on the time to establish full enteral feeds. Repeated-measures analysis indicated significant group differences in weight z scores at 36 weeks' PA and at discharge in favor of the intervention (p < 0.05). CONCLUSION These data indicate that the smell and taste of milk may improve milk tolerance and weight in preterm infants. The role of regular smell and taste in promoting enteral nutrition and growth in preterm infants merits a larger trial powered to detect important outcomes.
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Affiliation(s)
- Friederike Beker
- Neonatal Services, Mercy Hospital for Women, Melbourne, VIC, Australia
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14
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Abstract
AIM Extremely preterm (EPT, born <28 weeks gestation) or extremely low birthweight (ELBW, birthweight <1000 g) individuals are at increased risk of high blood pressure (BP) and cardiovascular disease. We compared office BP measurements with 24-h ambulatory BP measurement (ABP) in EPT/ELBW individuals at age 18 years and term controls, and determined the sensitivity and specificity of office BP in predicting masked hypertension (24-h ABP measurements > 130/80). METHODS All EPT/ELBW individuals and matched term control adolescents born in Victoria, Australia, between 1991 and 1992 were recruited. A subset of this cohort was seen at 18 years, and researchers blinded to birth status measured office BP and ABP. We established the office BP thresholds that had the highest sensitivity and specificity in predicting masked hypertension. RESULTS EPT/ELBW (N = 120) individuals had higher mean BP measurements at 18 years, compared with controls (N = 71). Although there were no significant differences in rates of high BP between groups, high proportions of both EPT/ELBW (43.3%) and term control (36.6%) participants met criteria for masked systolic hypertension. In EPT/ELBW individuals, office systolic BP measurement of ≥122.5 mmHg predicted masked systolic hypertension (sensitivity 79%, specificity 74%). Office diastolic BP measurement of ≥75.5 mmHg predicted masked diastolic hypertension (sensitivity 77%, specificity, 77%). CONCLUSIONS At age 18 years, EPT/ELBW individuals have higher systolic and diastolic BP, compared with controls. Office BP may be an adequate screen for masked hypertension in EPT/ELBW survivors, but further research is needed to identify accurate ABP thresholds for masked hypertension for young Australians.
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Affiliation(s)
- Johanna C Centra
- Department of Paediatrics, Barwon Health, Geelong, Victoria, Australia
| | - Gehan Roberts
- Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Gillian Opie
- Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Jeanie Cheong
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
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Schmidt B, Roberts RS, Davis PG, Doyle LW, Asztalos EV, Opie G, Bairam A, Solimano A, Arnon S, Sauve RS, Cairnie J, Dix J, Adams BA, Warriner E, Marie Kim MH, Anderson P, Davis P, Doyle L, Argus B, Callanan C, Davis N, Duff J, McDonald M, Asztalos E, Hohn D, Lacy M, Haslam R, Barnett C, Goodchild L, Lontis RM, Fraser S, Keng J, Saunders K, Opie G, Kelly E, Woods H, Marchant E, Turner AM, Davis N, Magrath E, Williamson A, Bairam A, Bélanger S, Fraser A, Blayney M, Lemyre B, Frank J, Solimano A, Synnes A, Grunau RE, Hubber-Richard P, Rogers M, Mackay M, Petrie-Thomas J, Butt A, van Wassenaer A, Nuytemans D, Houtzager B, van Sonderen L, Regev R, Itzchack N, Arnon S, Chalaf A, Ohlsson A, O'Brien K, Hamilton AM, Chan ML, Sankaran K, Proctor P, Golan A, Goldsch-Lerman E, Reynolds G, Dromgool B, Meskell S, Parr V, Maher C, Broom M, Kecskes Z, Ringland C, McMillan D, Spellen E, Sauve RS, Christianson H, Anseeuw-Deeks D, Creighton D, Heath J, Alvaro R, Chiu A, Porter C, Turner G, Moddemann D, Granke N, Penner K, Bow J, Mulder A, Wassenberg R, van der Hoeven M, Clarke M, Parfitt J, Parker K, Nwaesei C, Ryan H, Saunders C, Schulze A, Wermuth I, Hilgendorff A, Flemmer AW, Herlenius E, Legnevall L, Lagercrantz H, Matthew D, Amos W, Tulsiani S, Tan-Dy C, Turner M, Phelan C, Shinwell ES, Levine M, Juster-Reicher A, Khairy M, Grier P, Vachon J, Perepolkin L, Barrington KJ, Sinha SK, Tin W, Fritz S, Walti H, Royer D, Halliday H, Millar D, Mayes C, McCusker C, McLaughlin O, Fahnenstich H, Tillmann B, Weber P, Wariyar U, Embleton N, Swamy R, Bucher HU, Fauchere JC, Dietz V, Harikumar C, Tin W, Fritz S, Schmidt B, Anderson PJ, Asztalos EV, Barrington KJ, Davis PG, Dewey D, Doyle LW, Grunau RE, Moddemann D, Ohlsson A, Roberts RS, Solimano A, Tin W, Gent M, Fraser W, Hey E, Perlman M, Thorpe K, Gray S, Roberts RS, Chambers C, Costantini L, Yacura W, McGean E, Scapinello L. Prediction of Late Death or Disability at Age 5 Years Using a Count of 3 Neonatal Morbidities in Very Low Birth Weight Infants. J Pediatr 2015; 167:982-6.e2. [PMID: 26318030 DOI: 10.1016/j.jpeds.2015.07.067] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/08/2015] [Accepted: 07/30/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate bronchopulmonary dysplasia (BPD), serious brain injury, and severe retinopathy of prematurity (ROP) as predictors of poor long-term outcome in very low birth weight infants. STUDY DESIGN We examined the associations between counts of the 3 morbidities and long-term outcomes in 1514 of 1791 (85%) infants with birth weights of 500-1250 g who were enrolled in the Caffeine for Apnea of Prematurity trial from October 1999, to October 2004, had complete morbidity data, and were alive at 36 weeks postmenstrual age (PMA). BPD was defined as use of supplemental oxygen at 36 weeks PMA. Serious brain injury on cranial ultrasound included grade 3 and 4 hemorrhage, cystic periventricular leucomalacia, porencephalic cysts, or ventriculomegaly of any cause. Poor long-term outcome was death after 36 weeks PMA or survival to 5 years with 1 or more of the following disabilities: motor impairment, cognitive impairment, behavior problems, poor general health, deafness, and blindness. RESULTS BPD, serious brain injury, and severe ROP occurred in 43%, 13%, and 6% of the infants, respectively. Each of the 3 morbidities was similarly and independently correlated with poor 5-year outcome. Rates of death or disability (95% CI) in children with none, any 1, any 2, and all 3 morbidities were 11.2% (9.0%-13.7%), 22.9% (19.6%-26.5%), 43.9% (35.5%-52.6%), and 61.5% (40.6%-79.8%), respectively. CONCLUSIONS In very low birth weight infants who survive to 36 weeks PMA, a count of BPD, serious brain injury, and severe ROP predicts the risk of a late death or survival with disability at 5 years.
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Affiliation(s)
- Barbara Schmidt
- Division of Neonatology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Robin S Roberts
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Peter G Davis
- Department of Obstetrics and Gynecology, University of Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynecology, University of Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | | | - Aida Bairam
- Department of Pediatrics, Laval University, Quebec City, Quebec, Canada
| | - Alfonso Solimano
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reginald S Sauve
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Marcus CL, Meltzer LJ, Roberts RS, Traylor J, Dix J, D'ilario J, Asztalos E, Opie G, Doyle LW, Biggs SN, Nixon GM, Narang I, Bhattacharjee R, Davey M, Horne RSC, Cheshire M, Gibbons J, Costantini L, Bradford R, Schmidt B. Long-term effects of caffeine therapy for apnea of prematurity on sleep at school age. Am J Respir Crit Care Med 2015; 190:791-9. [PMID: 25171195 DOI: 10.1164/rccm.201406-1092oc] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain. OBJECTIVES We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep. METHODS A total of 201 ex-preterm children aged 5-12 years who participated as neonates in a double-blind, randomized, controlled clinical trial of caffeine versus placebo underwent actigraphy, polysomnography, and parental sleep questionnaires. Coprimary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography. MEASUREMENTS AND MAIN RESULTS There were no significant differences in primary outcomes between the caffeine group and the placebo (adjusted mean difference of -6.7 [95% confidence interval (CI) = -15.3 to 2.0 min]; P = 0.13 for actigraphic total sleep time; and adjusted rate ratio [caffeine/placebo] for apnea-hypopnea index of 0.89 [95% CI = 0.55-1.43]; P = 0.63). Polysomnographic total recording time and total sleep time were longer in the caffeine group, but there was no difference in sleep efficiency between groups. The percentage of children with obstructive sleep apnea (8.2% of caffeine group versus 11.0% of placebo; P = 0.22) or elevated periodic limb movements of sleep (17.5% in caffeine group versus 11% in placebo group) was high, but did not differ significantly between groups. CONCLUSIONS Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood. Ex-preterm infants, regardless of caffeine status, are at risk for obstructive sleep apnea and periodic limb movements in later childhood.
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Affiliation(s)
- Carole L Marcus
- 1 Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Carroll KE, Lenne BS, McEgan K, Opie G, Amir LH, Bredemeyer S, Hartmann B, Jones R, Koorts P, McConachy H, Mumford P, Polverino J. Breast milk donation after neonatal death in Australia: a report. Int Breastfeed J 2014; 9:23. [PMID: 25530794 PMCID: PMC4271333 DOI: 10.1186/s13006-014-0023-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/17/2014] [Indexed: 11/16/2022] Open
Abstract
Lactation and breast milk can hold great value and meaning for grieving mothers who have experienced a recent death of an infant. Donation to a human milk bank (HMB) as an alternative to discarding breast milk is one means of respecting the value of breast milk. There is little research, national policy discussion, or organizational representation in Australia on the subject of breast milk donation after infant death. On 29 November 2013 the Mercy Hospital for Women in Melbourne, Australia hosted Australia’s first National Stakeholder Meeting (NSM) on the topic of milk donation after neonatal death. The NSM drew together representatives from Australian HMBs, neonatal intensive care units (NICUs) currently using donor human milk, and Australia’s chief NICU parent support organization. The NSM was video-recorded and transcribed, and analyzed thematically by researchers. This article reports the seven dominant themes discussed by stakeholders during the NSM: the spectrum of women’s lactation and donation experiences after infant death; the roles of the HMB and NICU in meeting the needs of the bereaved donor; how bereaved mothers’ lactation autonomy may interface with a HMB’s donation guidelines; how milk donation may be discussed with bereaved mothers; the variation between four categories of milk donation after neonatal death; the impact of limited resources and few HMBs on providing donation programs for bereaved mothers in Australia. This article provides evidence from researchers and practitioners that can assist HMB staff in refining their bank’s policy on milk donation after infant death, and provides national policy makers with key considerations to support lactation, human milk banking, and bereavement services nation-wide.
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Affiliation(s)
- Katherine E Carroll
- Faculty of Arts and Social Sciences, University of Technology Sydney, PO Box 123, Sydney, NSW 2007 Australia ; Faculty of Health Sciences, Mayo Clinic, Harwick 2, 200 First St SW, Rochester, MN 50091 USA
| | - Brydan S Lenne
- Faculty of Arts and Social Sciences, University of Technology Sydney, PO Box 123, Sydney, NSW 2007 Australia
| | - Kerri McEgan
- Mercy Hospital for Women, 163 Studley Rd, Heidelberg, Melbourne, VIC 3084 Australia
| | - Gillian Opie
- Mercy Hospital for Women, 163 Studley Rd, Heidelberg, Melbourne, VIC 3084 Australia
| | - Lisa H Amir
- Judith Lumley Centre, La Trobe University, 215 Franklin St, Melbourne, VIC 3000 Australia ; Royal Women's Hospital, Parkville, Melbourne, VIC 3053 Australia
| | - Sandra Bredemeyer
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050 Australia
| | - Ben Hartmann
- King Edward Memorial Hospital, 374 Bagot Rd, Subiaco, WA 6008 Australia ; School of Pediatrics and Child Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
| | - Rachel Jones
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050 Australia
| | - Pieter Koorts
- Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD 4006 Australia
| | - Helen McConachy
- Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD 4006 Australia
| | - Patricia Mumford
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050 Australia
| | - Jan Polverino
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050 Australia
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Sia KL, Gold L, Jacobs S, Cheong J, Opie G, Garland S, Donath S, Hickey L, Boland R, Webster C. Hospital Drg Costing and Health Services Use of Very Pre-Term Infants From the Proprems Neuro Study Across 10 Hospitals in Australia and New Zealand. Value Health 2014; 17:A518-A519. [PMID: 27201612 DOI: 10.1016/j.jval.2014.08.1613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K L Sia
- Deakin Health Economics, Melbourne, Australia
| | - L Gold
- Deakin Health Economics, Melbourne, Australia
| | - S Jacobs
- Royal Women's Hospital, Melbourne, Australia
| | - J Cheong
- Royal Women's Hospital, Melbourne, Australia
| | - G Opie
- Mercy Hospital for Women, Melbourne, Australia
| | - S Garland
- Royal Women's Hospital, Melbourne, Australia
| | - S Donath
- Murdoch Children's Research Institute, Melbourne, Australia
| | - L Hickey
- Royal Women's Hospital, Melbourne, Australia
| | - R Boland
- Murdoch Children's Research Institute, Melbourne, Australia
| | - C Webster
- Northern Hospital, Melbourne, Australia
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Forster DA, Jacobs S, Amir LH, Davis P, Walker SP, McEgan K, Opie G, Donath SM, Moorhead AM, Ford R, McNamara C, Aylward A, Gold L. Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial. BMJ Open 2014; 4:e006571. [PMID: 25358679 PMCID: PMC4216858 DOI: 10.1136/bmjopen-2014-006571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/02/2014] [Accepted: 10/06/2014] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact. METHODS AND ANALYSIS Women will be recruited from 34 weeks gestation to a multicentre, two arm, unblinded randomised controlled trial. The intervention starts at 36 weeks. Randomisation will be stratified by site, parity and diabetes type. Women allocated to the intervention will be taught expressing and encouraged to hand express twice daily for 10 min and keep an expressing diary. The sample size of 658 (329 per group) will detect a 10% difference in proportion of babies admitted to SCN/NICU (85% power, α 0.05). Data are collected at recruitment (structured questionnaire), after birth (abstracted from medical record blinded to group), and 2 and 12 weeks postpartum (telephone interview). DATA ANALYSIS the intervention group will be compared with the standard care group by intention to treat analysis, and the primary outcome compared using χ(2) and ORs. ETHICS AND DISSEMINATION Research ethics approval will be obtained from participating sites. Results will be published in peer-reviewed journals and presented to clinicians, policymakers and study participants. TRIAL REGISTRATION NUMBER Australian Controlled Trials Register ACTRN12611000217909.
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Affiliation(s)
- Della A Forster
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan Jacobs
- Royal Women's Hospital, Parkville, Victoria, Australia
- Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
| | - Lisa H Amir
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
| | - Peter Davis
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Kerri McEgan
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Gillian Opie
- Department of Obstetrics and Gynaecology, University of Melbourne, Carlton, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan M Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Anita M Moorhead
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rachael Ford
- Judith Lumley Centre (formerly Mother & Child Health Research), La Trobe University, Melbourne, Victoria, Australia
- Royal Women's Hospital, Parkville, Victoria, Australia
| | | | | | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
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Roberts G, Cheong J, Opie G, Carse E, Davis N, Duff J, Lee KJ, Doyle L. Growth of extremely preterm survivors from birth to 18 years of age compared with term controls. Pediatrics 2013; 131:e439-45. [PMID: 23296433 DOI: 10.1542/peds.2012-1135] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine changes in height, weight, and BMI of extremely preterm (EPT; gestational age <28 completed weeks) survivors from birth to 18 years of age, compared with term controls. METHODS Birth, discharge, and follow-up at ages 2, 5, 8, and 18 years of consecutive EPT survivors and contemporaneous term controls born in 1991-1992 in Victoria, Australia. Weight, height, and BMI were converted to z scores and compared between groups. Height z scores at age 2 and midparental height z scores were examined as predictors of height z score at age 18 years. RESULTS Follow-up rates were >90% until 18 years, when 166 (74%) of 225 EPT subjects and 153 (60%) of 253 controls were assessed. EPT subjects had lower weight z scores than controls at birth, with a much greater difference at discharge, which reduced progressively until age 18 years. EPT children were shorter than controls at all ages, and this difference did not alter greatly over time. BMI z scores were lower in EPT children at younger ages, but by age 18 were similar between groups. Height at age 2 was a better predictor of height at age 18 in EPT participants, compared with midparental height. CONCLUSIONS EPT survivors were substantially lighter than term controls from birth to late adolescence, although the gap in weight steadily decreased over time from a peak at the time of discharge. The height disadvantage in EPT children compared with controls remained constant over time and BMI scores were similar at age 18 years.
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Affiliation(s)
- Gehan Roberts
- Centre for Community Child Health, The Royal Children's Hospital, Flemington Rd, Parkville, 3052, Australia.
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Garland SM, Tobin JM, Pirotta M, Tabrizi SN, Opie G, Donath S, Tang MLK, Morley CJ, Hickey L, Ung L, Jacobs SE. The ProPrems trial: investigating the effects of probiotics on late onset sepsis in very preterm infants. BMC Infect Dis 2011; 11:210. [PMID: 21816056 PMCID: PMC3199779 DOI: 10.1186/1471-2334-11-210] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/04/2011] [Indexed: 01/01/2023] Open
Abstract
Background Late onset sepsis is a frequent complication of prematurity associated with increased mortality and morbidity. The commensal bacteria of the gastrointestinal tract play a key role in the development of healthy immune responses. Healthy term infants acquire these commensal organisms rapidly after birth. However, colonisation in preterm infants is adversely affected by delivery mode, antibiotic treatment and the intensive care environment. Altered microbiota composition may lead to increased colonisation with pathogenic bacteria, poor immune development and susceptibility to sepsis in the preterm infant. Probiotics are live microorganisms, which when administered in adequate amounts confer health benefits on the host. Amongst numerous bacteriocidal and nutritional roles, they may also favourably modulate host immune responses in local and remote tissues. Meta-analyses of probiotic supplementation in preterm infants report a reduction in mortality and necrotising enterocolitis. Studies with sepsis as an outcome have reported mixed results to date. Allergic diseases are increasing in incidence in "westernised" countries. There is evidence that probiotics may reduce the incidence of these diseases by altering the intestinal microbiota to influence immune function. Methods/Design This is a multi-centre, randomised, double blinded, placebo controlled trial investigating supplementing preterm infants born at < 32 weeks' gestation weighing < 1500 g, with a probiotic combination (Bifidobacterium infantis, Streptococcus thermophilus and Bifidobacterium lactis). A total of 1,100 subjects are being recruited in Australia and New Zealand. Infants commence the allocated intervention from soon after the start of feeds until discharge home or term corrected age. The primary outcome is the incidence of at least one episode of definite (blood culture positive) late onset sepsis before 40 weeks corrected age or discharge home. Secondary outcomes include: Necrotising enterocolitis, mortality, antibiotic usage, time to establish full enteral feeds, duration of hospital stay, growth measurements at 6 and 12 months' corrected age and evidence of atopic conditions at 12 months' corrected age. Discussion Results from previous studies on the use of probiotics to prevent diseases in preterm infants are promising. However, a large clinical trial is required to address outstanding issues regarding safety and efficacy in this vulnerable population. This study will address these important issues. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN012607000144415 The product "ABC Dophilus Probiotic Powder for Infants®", Solgar, USA has its 3 probiotics strains registered with the Deutsche Sammlung von Mikroorganismen und Zellkulturen (DSMZ - German Collection of Microorganisms and Cell Cultures) as BB-12 15954, B-02 96579, Th-4 15957.
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Affiliation(s)
- Suzanne M Garland
- Women's Centre for Infectious Diseases, Bio 21 Institute, 30 Flemington Road, Parkville, Victoria 3052, Australia.
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Lewis AJ, Galbally M, Opie G, Buist A. Neonatal growth outcomes at birth and one month postpartum following in utero exposure to antidepressant medication. Aust N Z J Psychiatry 2010; 44:482-7. [PMID: 20397792 DOI: 10.3109/00048670903559593] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is evidence of increasing prescription of antidepressant medication in pregnant women. This has arisen from the recognition of the importance of treating maternal depression. This must be balanced, however, with information on outcomes for infants and children exposed to antidepressants in pregnancy. The aim of the present study was to examine whether neonatal outcomes including gestational age at birth, neonatal growth outcomes at birth and then at 1 month postpartum were altered by in utero exposure to antidepressant medication using a prospective and controlled design. METHOD A prospective case-control study recruited 27 pregnant women taking antidepressant medication and 27 matched controls who were not taking antidepressant medication in pregnancy at an obstetric hospital in Melbourne, Australia. Of the 27 women taking medication, 25 remained on medication in the third trimester. A purpose-designed self-report questionnaire and the Beck Depression Inventory-II were completed in pregnancy, after birth and at one month postpartum. In addition information was collected on exposed and non-exposed infants including Apgar scores, birthweight/length/head circumference and gestational age at birth. Weight/length/head circumference was again collected at 1 month of age. RESULTS Infants exposed to antidepressants in utero were eightfold more likely to be born at a premature gestational age, had significantly lower birthweight and were smaller in length and head circumference than non-exposed infants. There was no association between birth outcomes and maternal depression. At 1 month, the difference in weight in the exposed group became significantly greater than the control group. CONCLUSION Antidepressant exposure in utero may affect gestational age at birth and neonatal outcomes independently of antenatal maternal depression. Further studies are needed to examine whether these findings vary according to the type of antidepressant prescribed and follow up growth and development in exposed infants beyond 1 month.
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Affiliation(s)
- Andrew J Lewis
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
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Forster DA, McEgan K, Ford R, Moorhead A, Opie G, Walker S, McNamara C. Diabetes and antenatal milk expressing: a pilot project to inform the development of a randomised controlled trial. Midwifery 2009; 27:209-14. [PMID: 19615797 DOI: 10.1016/j.midw.2009.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 04/30/2009] [Accepted: 05/20/2009] [Indexed: 12/17/2022]
Abstract
OBJECTIVE infants of women with diabetes in pregnancy are at increased risk of hypoglycaemia. If the infant's blood glucose is low and the mother is unable to breast feed/provide sufficient expressed breast milk, infants are often given formula. Some hospitals encourage women with diabetes to express breast milk before birth. However, there is limited evidence for this practice, including its impact on labour and birth, e.g. causing premature birth may be a concern. A pilot study was undertaken to establish the feasibility of conducting an adequately powered randomised controlled trial to evaluate this practice. DESIGN consecutive eligible women with pre-existing or gestational diabetes (requiring insulin), planning to breast feed and attending the study hospital were offered participation. INCLUSION CRITERIA 34-36 weeks of gestation; singleton pregnancy; cephalic presentation; and able to speak, read and write in English. EXCLUSION CRITERIA history of spontaneous preterm birth, antepartum haemorrhage, placenta praevia and suspected fetal compromise. Women were encouraged to express colostrum twice a day from 36 weeks of gestation, and advised how to store the colostrum, which was frozen for their infant's use after birth. They were asked to keep a diary documenting their expressing. DATA demographic questionnaire, telephone interview at six and 12 weeks postpartum and medical record data. SETTING a public, tertiary, women's hospital in Melbourne, Australia. PARTICIPANTS 43 women with diabetes in pregnancy (requiring insulin). FINDINGS cardiotocographs were undertaken after the first expressing episode and none of the infants showed any sign of fetal compromise. Forty per cent of infants received formula in the 24 hours postpartum. The proportion of infants receiving any breast milk at six weeks was 90%, and this decreased to 75% at 12 weeks. No women showed evidence of hypoglycaemia post expressing. The intervention was positively received by most women; 95% said that they would express antenatally again if the practice proved to be beneficial. The amount of colostrum varied according to the number of expressions, the length of time in the study and the time spent expressing, with a median of 14 days expressing and 39.6 ml of colostrum obtained. KEY CONCLUSIONS the small number of women in this pilot was not an adequate number to examine safety or efficacy, but this study does provide evidence that it would be feasible and desirable to conduct a randomised controlled trial of antenatal milk expressing for women with diabetes requiring insulin in pregnancy. IMPLICATIONS FOR PRACTICE it is important that this widespread practice undergoes rigorous evaluation to assess both efficacy and safety. Until such evidence is available, the authors suggest that the routine encouragement of antenatal milk expressing in women with diabetes in pregnancy should cease.
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Affiliation(s)
- Della A Forster
- Mother and Child Health Research, La Trobe University, 324–328 Little Lonsdale Street, Melbourne, Australia.
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Affiliation(s)
- Annie Leong
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, East Melbourne, Victoria, Australia
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Affiliation(s)
- G Opie
- IBCLC, Mercy Hospital for Women, Melbourne, Victoria, Australia
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Acton C, Pahuja M, Opie G, Woodward A. A 5-year audit of 778 neonatal renal scans (Part 2). Miscellaneous anomalies in 59 infants: A pictorial presentation. ACTA ACUST UNITED AC 2003; 47:354-62. [PMID: 14641185 DOI: 10.1046/j.1440-1673.2003.01202.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this 5-year review of 778 neonatal renal scans seen in an obstetric hospital, Mercy Hospital for Women, Melbourne, most infants were referred because of antenatal ultrasound findings. Ninety-two percent of these had fetal pyelectasis. The results were classified on the ultrasound findings. The majority of neonates (76%) had a normal postnatal scan. A number had vesicoureteric reflux found on micturating cystourethrogram. Persisting mild/moderate pyelectasis or hydronephrosis (15%) proved to be a normal variant in many infants, but had a similar appearance to those with an early obstructive cause (1%). There were 59 infants (8%) with a miscellaneous group of renal anomalies, many with a characteristic antenatal ultrasound appearance suggesting the diagnosis. Review of these 59 infants illustrates the anomalies seen and reports the associated investigations and subsequent outcome in most cases.
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Affiliation(s)
- Christine Acton
- Department of Medical Imaging, Mercy Hospital for Women, East Melbourne, Victoria, Australia.
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Acton C, Pahuja M, Opie G, Woodward A. A 5-year audit of 778 neonatal renal scans (Part 1): Perplexing pyelectasis and suggested protocol for investigation. ACTA ACUST UNITED AC 2003; 47:349-53. [PMID: 14641184 DOI: 10.1046/j.1440-1673.2003.01201.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this 5-year review of 778 neonatal renal scans seen in an Obstetric Hospital, most infants were referred because of antenatal ultrasound findings, 92% with fetal pyelectasis. The results were classified according to the ultrasound findings. The majority of neonates (76%) had a normal postnatal scan. A number had vesicoureteric reflux (VUR) found on a micturating cystourethrogram. Persistant mild to moderate pyelectasis or hydronephrosis (15%) proved to be a normal variant in many infants, but had a similar appearance to those with an early obstructive cause (1%). Pyelectasis has proved to be a poor predictor of VUR. A protocol outlining paediatric management for neonates with persisting pyelectasis is included. There were 59 infants (8%) with a miscellaneous group of renal anomalies, many with a characteristic antenatal ultrasound appearance suggesting the diagnosis. These infants have been separately reported and illustrated (Part 2). Overall, 13% of infants were found to have significant findings of obstruction, VUR or miscellaneous anomalies affecting management.
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Affiliation(s)
- Christine Acton
- Department of Medical Imaging, Mercy Hospital for Women, East Melbourne, Victoria, Australia.
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